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General NPI Number Information
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NPI Number | 1619237575
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Entity Type | Organization
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Legal Business Name | DR VICKI LEE LLC
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 410 W NINE MILE RD SUITE C
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City | PENSACOLA
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State | FL
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Zip | 32534-1820
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Country | US
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Telephone | 850-471-0000
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Fax | 850-471-0012
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Provider Business Mailing Address
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Address Line | 6036 BLAIR CIR
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City | GULF BREEZE
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State | FL
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Zip | 32563-7064
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Country | US
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Telephone | 850-471-0000
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Fax | 850-471-0012
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Authorized Official
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Title or Position | OWNER
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Name | VICKI LEE SCHWANTES
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Credential | DC
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Telephone | 850-471-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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